Child Immunisation Refusal Form

 
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All questions marked with a * are mandatory

This form should only be used when immunisation(s) are declined.
Please double check you've entered the correct email address
Please indicate which vaccine(s) are not required: *
I do not agree to my child receiving protection against any of the diseases stated.

Parents who refuse immunisation(s) are reminded that they may change their minds at any time. There is no upper age limit for immunisation.
For further information on childhood immunisations, visit Vaccine Knowledge 

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